Legalising Euthanasia: Compassion or Consumerism?

[My second attempt to grapple with, and provide counter-arguments to, the pro-euthanasia arguments. These are gaining increasing traction here in Australia at the moment, and it will probably only be a matter of time before this highly ambiguous ‘progress’ (legalisation of some form of voluntary euthanasia) also happens here. Majorities in Australia and most advanced industrial countries and almost all progressives support legalising voluntary euthanasia/assisted suicide, leaving counter-arguments mostly to the traditional religious faiths and many, if not most, in the medical professions. It’s quite ‘uncool’ to be against it. Readers of my blog will know that I am neither a medico nor a member of any religion, and that my approach to most social, political and spiritual matters is openly or tacitly informed by critical/radical social theory and radical/transcultural mysticism. I fear increasing ‘spiritual flatland’. At my age of course, questions of death and dying become ever more central, so apologies to all my younger readers understandably usually not interested in such matters. I took the photo in an aged-care home.]

‘Euthanasia’, from the Greek, means a ‘good death’. Opinions of course diverge over what is ‘good’ and what is not. The reason this issue cuts so deeply is because it automatically reveals one’s opinions, or tacit assumptions, about a ‘good life’ and a ‘good society’, and these, in turn, are inherently based on one’s deepest beliefs or tacit assumptions about the meaning of life, one’s true identity, about body, soul and spirit. Let us try and unpack this thesis a little.

Consensus

Before divergences of opinion open up about legalising voluntary euthanasia in Australia, it may be useful both to acknowledge the compassionate motivations of both pro and con positions and to delimit the area of consensus that most people on both sides of the argument would probably share.

My understanding is that most participants in this dialogue would agree that (a) involuntary euthanasia is to be emphatically rejected, (b) ‘passive euthanasia’ is acceptable where someone has stated that they desire it (as currently practised), (c) unnecessary, overwhelming pain is to be alleviated (e.g. as palliative sedation, as also usually currently practised), (d) given a justified fear of dying in institutional loneliness and isolation, palliative, hospice and home-dying support services should be better funded and improved, (e) suicide prevention services should be better funded and improved, (f) no doctor or carer against voluntary euthanasia or assisted suicide should be legally obliged to directly or indirectly (e.g. via referral) engage in the practice.

Beyond these six points of possible consensus, I would ask voluntary euthanasia advocates whether they might also agree to two further exclusions from any possible legalisation, namely that there be no legal voluntary euthanasia or assisted suicide for (i) children, and (ii) people suffering from psychological crises (including anxiety, depression or aggravated grieving)?

The Pro Position: Compassion, Free Choice, Dignity

The expressed motivation of voluntary euthanasia advocates is a compassion with the pain and suffering that the dying or terminally ill may experience. The wish is often expressed that the dying should end life in dignity, and this is usually linked both with an elimination or minimisation of physical pain and the fact that the time and form of the dying should ideally be a matter of rational, independent choice. Three statements often made by voluntary euthanasia advocates would seem to encapsulate these notions:

(c) ‘I saw my parent lose their memory/become incontinent/have falls/become dependent on the care of others/commit suicide in a violent way… and I know that is not how they would have wanted to die.’

Hidden Assumptions

Let us try and unpack some of the hidden assumptions in these commonly expressed opinions.

Ad (a) The Dog Compassion Argument

The tacit assumption made here is that humans are nothing more than animals (bio-equality), that killing a human (or assisting them to kill themselves) is the same as killing a dog.

If this notion of bio-equality is accepted, then, logically, the moral equality of beings should be expandable downwards: killing a fly is the same as killing a dog, killing a carrot the same as killing a fly. The people shooting rabbits or working in an abattoir killing cattle to help feed people will then be just as morally culpable and criminal as those working the gas chambers at Auschwitz.

I disagree with this assumption. Although one can agree that all life is, in the deepest, mystical sense, sacred (and thus equal in ‘ultimate value’ in that deepest sense), I would argue that in this world we live in we cannot live responsibly without some sort of moral hierarchy of value we apportion to beings. When further unpacked, we will probably find that this hierarchy of value is based on some notion of evolved depth of interiority and inclusiveness. Just as molecules include atoms but atoms do not include molecules or cells include molecules but molecules do not include cells, we humans include elements of carrots, flies and dogs but they do not include the evolved, truly human elements of us; we are thus ‘richer’ in the sense that we have more evolved interiority, reflexivity, and more inclusiveness.

Except for some few animal rights extremists, I think this is intuitively or consciously felt by most people, whatever their attitude to euthanasia. For example, a woman suffering from intermittent dementia whose husband later killed, or involuntarily ‘euthanised’, her with an overdose of sleeping tablets because he personally judged her life no longer worth living, stated her shocked realisation of his intention as: ‘he wants to have me put down like a dog.’ (N. Barrowclough, ‘Till death do us part’, SMH Good Weekend, 2/4/2016)

Ad (b) The Free Choice Argument

The tacit assumption here is that my dying is a thing, an external event, a possession I want to be able to choose, manipulate, consume, control like my jobs, cars etc., like all my other possessions and items of consumption.

The speaker voicing this opinion (who happens to be the euthanizing husband mentioned above) will believe this opinion to be their very ‘own’ and just ‘common sense’. They will not be aware that this opinion is certainly not ‘common sense’ in other cultures, and carries hidden assumptions deeply rooted in our particular society and culture. Indeed, when looked at from ‘above’, one could argue that in this case it almost seems as if modern consumer society and its core assumptions might be speaking almost directly through the mind of an individual closely adapted to its norms. It is the increasingly widespread rationality of ‘possessive individualism’ taken to its limit in the neoliberal age of totalised consumerism. It is a cultural construct and social identity formation that only arose in western Europe around five hundred years ago as an expression of the rising bourgeoisie and is now globalizing as the last countries are industrialized.

Death and dying, once the ultimate ‘other’, a spiritual challenge, journey or mystery beyond anyone’s ego control, has now been reduced to a mainly physical event, an ultimate commodity and possession, and the right to choose, possess and control it is, like shopping, seen as a ‘freedom’ and ‘human right’.

This could be interpreted as the western (Cartesian) ‘ego ghost’, in fear of dying, trying to stop, or techno-medically ‘buy’ its way out of, the ‘body machine’ it feels simultaneously separate from and trapped within, as it runs down. It wants to possess, control, consume death like a thing. If there is any truth in this interpretation, can there really be talk of ‘freedom’ and ‘freedom of choice’ if, whether acknowledged or not, it is a deep fear that is actually driving the choice? If death and dying is externally, scientistically defined as mainly a physical or medical problem or crisis, then in western consumerist thinking there must be some suicide pill or machine to ‘fix it for me’. Thus another existential, internal, challenge given with simply being human is turned into just another external, techno-medical issue.

This attitude is also very ‘male’ or ‘masculinist’ in the sense of an interventionist, hard-nosed feeling of agency and ‘independence’ divorced from all relationship, interaction or communion with others, body and nature, the often feared soft, organic female aspect of life. As a male I am often socialized to demonstrate that I am ‘independent’ and ‘free’, ‘strong’ and ‘competitive’, by controlling my life, body and softer (‘feminine’) emotions like I control my various tools and machines. Many women, industrially and post-industrially ‘liberated’ into an economistic and competitive, form of equality, have now also internalised this masculinist form of agency and identity to a large degree.

Ad (c) The Dying with Dignity Argument

The tacit assumption here is that external surface events or facts are the same as internal ones, that one should somehow equate the sometimes ‘messy’ surface phenomena of dying and suffering with the deeper interior processes going on within those dying or suffering. This equation in turn probably presupposes that the latter processes (in the past equated with notions like ‘soul’ or ‘spirit’) do not really exist, i.e. that the person consists mainly of surface appearance.

To watch loved ones becoming demented, incontinent, depressed, killing themselves or dying painfully is often to be indeed overwhelmed with complex, painful feelings of various kinds, not least of which may be a deep sense of helplessness. There may perhaps even be an unconscious feeling of fear of something like this happening to oneself, of one’s ‘losing control’, one’s ‘freedom’ and ‘independence’.

In manic flight from this sense of helplessness, seeking greater inner stability and some sense of control and agency, one may very easily then project these painful feelings onto one’s loved ones and view them as losing something we circumscribe with the powerfully emotive word ‘dignity’. One may have a certain preconception of how dying SHOULD happen, and this preconception will be linked to many other complex ideas, feelings, surface impressions and images rather than to internal processes and meaning-making.

It could be said that at this precise point, caught up in a welter of ideas and painful feelings, one will most likely be blocked from relating to the actual and interior process of the loved one’s dying. One will no longer be actively listening, no longer really in dialogue, no longer empathically relating to one’s loved ones and trying to lovingly understand what they may be experiencing within themselves, even possibly sensitively aiding our loved ones in this process and growing ourselves in compassion and understanding. Instead, one is looking at them from the outside like a scientist, i.e. externally, monologically, as objects, as surfaces without interiority, and through a filter of various surface preconceptions like ‘dignity’, ‘control, ‘independence’. This may also be because this is how one mostly tends to look at oneself and others.

Neither the Scientific World View nor Consumerism include Values like Dignity and Compassion

The common denominator of the above attitudes is that of an externalised, physicalized, quasi-scientific view of suffering, death and dying. The role of science, however, is to reduce or banish suffering, not to ‘suffer-with’, i.e. have com-passion. Of course an individual scientist may, and usually will, feel compassion, but he does this as a human being, not as a scientist. Science is quantitative, based on measurement, external physical facts, data, surface behaviour, i.e. on the absence of qualities, values, subjective and intersubjective meaning-making, interiority, soul. Psycho-spiritually, science thus, necessarily, marks out a spiritual ‘flatland’ (Ken Wilber).

In the historical process of industrialisation, modernisation and secularisation, this externalising, objectifying, scientific attitude and corresponding spiritual flatland has increasingly become internalised and thus the cultural norm in advanced industrial countries. Many today see themselves as consisting mainly of physical organs, chemical processes and self-images, i.e. as objects, external surfaces without interiority or transcendence. These surfaces need to be monitored and maintained like machines (= ‘health’); they need to conform to conventional norms and standards of ‘beauty’ or ‘wellness’ as set by the profit-driven entertainment and culture industries.

The key (adolescent) values which are predominant here are ‘youthfulness’, ‘freshness’, ‘novelty’ as these are expressed in the planned obsolescence and commodity and fashion cycles needed to keep capitalism stable, i.e. economic growth going and the crises of underconsumption/overproduction minimised. If a ‘soul’ or ‘spirit’ is still believed in at all it is more in a reduced form as a psychological ego or self which is also felt as a part of external achieving and competing or in the other-directedness of gaining status or being liked.

Such other-directed values are the extrinsic values of marketing, economic exchange, money, the commodity, i.e. the alluring surface values of things that are bought and sold, their reified voices crying out everywhere not just from totalized advertising and celebrity industries but now also from the democratized self-image-marketing occurring in ‘social media’ and the cosmetic surgery and ‘wellness’ industries: ‘come buy me, and you will fulfil all your desires for status, beauty, youthfulness, sex, freedom, escape etc.’ The cultural norm is now increasingly that one works on one’s image, external surface, status updating, saleability, not on one’s interior development, understanding, compassion, mind-heart expansion. Beginning with post-war consumerism and the ‘other-directed lonely crowds’ (David Riesman) and ‘marketing characters’ (Erich Fromm) of the first TV generations, total digitalisation has now made this the increasingly prevalent worldview and mental ‘worldspace’.

Ageing, death and dying are of course the ultimate challenge to this worldview. How messy, how painful ageing and dying can be, that slow or rapid ‘withdrawal from appearance’ (Goethe), that destruction of all self-images cultivated over a lifetime, of all those bodily and psychological surfaces we were usually totally identified with in our busy, active, goal-directed, often love-and attention-seeking lives. Given the immense cultural and psychological hold that such identifications have over us, it is not surprising that even here we may seek to hold on to and maintain our image, our status, our internalised social roles, our supposed personal ‘uniqueness’, considering all these as core components of our real identities.

Even here, in an attempt to defend against the deep fear of these apparent losses, we may – in a classic Freudian defence mechanism ‒ seek to ‘flee forwards’, to ‘technically’ manage and control the process of ageing and dying as if these were merely external events, a destruction of mere surfaces. And the only way we think we can do this is by techno-medical attack and pre-emption, by putting an end to our external surfaces, our bodies, by radically intervening in the organic-spiritual process: by popping a pill and legalizing and normalizing assisted suicide and euthanasia.

Who Dies?

Yet WHO is here attempting to manage, control, intervene, curtail, put an end to whom or what? And WHO is dying? Is it not, fearing its own end, the self-image itself?

As in other key stages in our growth and development from conception to adulthood, is not the psycho-physical process or struggle of the ageing and dying perhaps also the complex, volatile process of letting go of the previous body- and self-image, of dis-identifying with it, of now, finally, opening up to our true identity, to what we really may be beyond appearances, beyond the body-self-image, the internalised social role? And would not that opening-up to the as yet unknown and mysterious (or ‘forgotten’) also be a form of deep love, of dignity, of compassion with oneself or, as active listening and dialogue, with those loved ones involved in the last process and struggle?

From such a non-objectifying, existential and interior view of living and dying, is not the real form of ‘dying in dignity’, of compassion with the dying, not to provide the means of killing or suicide but rather the means of support, pain alleviation, care, openness, listening and compassion that all will need as they struggle and come to terms with this last great human challenge and opportunity?